When You Can Control How Life Ends by Erin Pantalone

It’s Monday morning; your alarm is going of for the third time as you roll over and again hit snooze. The thought of getting out of bed consumes you with dread. Laying there you begin to cry as the anxiety overtakes you. Five more minutes pass, your alarm goes off again; this time you know it’s the final alarm and you must get up. You still find yourself panicking about having to face reality. It’s Monday you have kids to get ready for school, a job to report to, daily life functions that need to be handled. Despite all of that all you can do is lie in your bed and wonder if the world really needs you. Your next thought, reviewing your plan to put an end to your suffering because you’ve convinced yourself time and time again that everyone is better off without you.

            Suicide, the act or an instance of taking one's own life voluntarily and intentionally (“Definition of Suicide” 1). This is an epidemic that claims tens of thousands of lives a year.  According to the Center for Disease Control, in 2017 suicide was the tenth leading cause of death in the United States (“NIHM” 1). We live in a social media fueled society. Every day we read about another shooting, stabbing, or event that has led to another fatality, yet we do not seem to bat an eye. This has become the standard for our world these days. Homicides that we have become so accustom to hearing about, account for less deaths every year than suicide. Suicide is an epidemic that can be eradicated. We may not eliminate the issue as we would like but the number of deaths can be greatly decreased. The question is where do we start?

Suicide is not a modern-day epidemic. In fact it can be traced back to the biblical and ancient times. In ancient Greece suicide was not frowned upon so long as it was for justifiable reasons. Hardships, when it was “legally ordered by the State” (as in the case of Socrates) (“Nagel”1) and illness were all acceptable reasons for suicide. In the instance of Socrates; he was ordered to drink a fatal concoction after he was found guilty of not believing in the Gods and corrupting the youth of Ancient Greece. In the case of the Ancient Romans, suicide was permisable for all those except slaves and soldiers (“Nagel”1). Looking at suicide from a biblical standpoint, according to Thomas Nagel, in his piece “A Brief History of Suicide”, there are eleven instances in the bible where suicide is mentioned. Again, like the Greeks and Romans it did not appear in the bible that suicide was condemned. So, when did suicide become something that was no longer acceptable?

When you look at the middle ages this is where things appear to change in more ways than one. During these times, when a person was to commit suicide the persons body was drug, tortured, hung or staked through the chest (“Nagel”1) The middle ages may also be when suicide was first seen as a mental disorder. As we progress through the times especially into the Renaissance ages suicide is regarded more and more as an immoral act.  19^th Century England “non compos mentis” was coined by coroners for suicide victijms(“Nagel”1). The term “non compos mentis”, translated basically means not of sound mind. They felt the victims where not of sound mind at the moment of suicide.

Transition into the current times, suicide is still more or less socially unacceptable in most regions. There are places in the middle east that for religious purposes i.e.; suicide bombings, that it is an act that is embraced. Currently there are ten countries where physician assisted suicide is legal, but for the topic of this paper we are focusing on self-inflicted suicides. 

What exactly causes one to have suicidal thoughts and behaviors? Research has found that 46% of people who die by suicide had a known mental health condition ("Risk of Suicide” 1). Mental health issues may be one of the biggest factors in why someone carries out their death but there are other factors to consider as well. Some think there may be a family history or genetic link to suicide. Chronic illness is also another factor that plays into the possibility of why someone commits suicide. Other key factors can be abuse and trauma.

I’ve decided now is the time. I have meticulously planned out each step to ending my life. I replay the scenario repeatedly; making sure I haven’t missed a step; ensuring that my plan will be successful. My letter of apologies and regret has been penned, I have driven to an isolated location, I am ready to follow through. Why I am I hesitating? Everyone is better off without me I’m more of a burden than an asset or so I have thought. Surely my death will make things easier for everyone I love, won’t it?’

When an individual follows through on their suicide it leaves a wake of destruction for those left behind. Family and friends are left reeling with the effects. Those closest to you are going to feel an array of emotions; anger, pain, sorrow, guilt, and grief to name a few. The grief and the after math for those you have left here are not short lived. Some will spend years still processing and sorting through the emotions. Always wondering what if they had said or done something different, would you still be here?

What if you had been a prominent member of your community? Those members of your community would too be wondering and grieving. Although suicide seems like the perfect answer to solve your issues all it truly does is end your suffering. The aftermath it leaves for everyone else is something most people do not ever take into consideration before following through on their plan.

As it was mentioned earlier, suicide dates to ancient times. Tens of thousands of people a year, even extremely prominent and historical figures have carried out their suicides. One of the most notable suicides from the ancient times other than Socrates whom was discussed earlier is Cleopatra. Cleopatra attempted to seduce and win over Octavian after her empire was defeated by the Romans but was unsuccessful. “Rather than fall under Octavian’s domination, Cleopatra died by suicide on August 12, 30 B.C., possibly by means of an asp, a poisonous Egyptian serpent and symbol of divine royalty” ("Cleopatra Dies by Suicide"). Another notable suicide in history is that of Adolf Hitler. In April of 1943, Hitler who was hiding in a bunker committed suicide. He swallowed cyanide capsule and shooting himself in the head ("Adolf Hitler Commits Suicide in His Underground Bunker").

The numbers associated with this epidemic are shocking. In 2016 suicide was the 10th-leading cause of death (“Weinerman”1). As if that isn’t alarming enough, according to the same article, suicide was the second-leading cause of death among people ages 10 to 34 that same year. The rate at which the statistics continue to grow is frightening. Suicide has increased by about 1 percent per year from 2000 through 2006 and by about 2 percent per year from 2006 through 2016 (“Weinerman” 1).

            What are the odds that suicide would strike the same family more than once? Statistically that can’t be answered, at least not yet. From a personal standpoint, I can verify it can happen more than once. My family has experienced this tragedy twice. In January of 2010 my cousin was finally successful in taking her own life. She was a young, vibrant woman who in her early twenties started experiencing mental health issues. By the time of her death she had been diagnosed with bipolar and schizophrenia. She had two previous attempts to take her life that had been unsuccessful resulting in psychiatric hospital stays. When she was finally successful it rocked my family to the core. Fast forward nine years and tragedy strikes again. October of 2018 my mother after many failed attempts was able to succeed. As with my cousin my mother also had been battling mental health issues. In her circumstance though it had been most of her life she dealt with it. I can remember her first attempt when I was still in High School. Over the next 17 years, there were five other attempts that someone was able to intervene on at just the right moment. Having to experience the tragedy of suicide once is unpleasant enough, twice is absolutely horrific; especially when it is your mother. Statistically since so many suicides and suicide attempts are linked to mental health and possibly genetics, how do we stop this epidemic?      

          Over the span of the last eighteen years, suicide rates have been a roller coaster, they rise and then they fall, only to climb again. According to the CDC, between 1999 and 2017, the rate increased 33%, (“Hedegaard”1) despite all of the fluctuation and studies there still doesn’t seem to be any real cure in sight. Since suicide and suicide attempts are carried out in a variety of different ways, how do we put an end to it? The most obvious choice would be to address the issue that seems to be a common denominator in all the victims of the epidemic, and that is mental health. According to a research article on NCBI, Psychological autopsies from the middle of the previous century revealed that most people who have died by suicide have suffered from mental disorders. 90% of those who committed suicide had a psychiatric diagnosis at the time of death.

             

In the image above, you can see that the top three disorders associated with suicide have been either a mood disorder, schizophrenia and substance abuse. Treating these issues will help cut down on the amount of suicides. Since suicide is so complex being that it involves not only psychological issues, but biological, cultural and environmental issues as well when you link it to substance abuse, it is going to require a variety of treatment. When looking at issues such as mood disorders in regard to suicide, a treatment such as Cognitive Behavioral Therapy (CBT) is an evidence-based method for reducing suicide attempt rates and improving adherence to treatment. This treatment has been shown to be effective when directly focused on reducing aspects of suicidal behavior (“Bradvik”1). Another approach to treating mood disorders would be a pharmacological treatment. Lithium is reported to reduce both attempted and completed suicides in major mood disorders, such as unipolar depression and bipolar patients with long-term lithium treatment (“Bradvik”1). Extended use of lithium may reduce the number of suicidal actions, but it is also a cause for concern that a patient could use it to overdose. It is vital that physicians monitor patient and educate them to ensure proper treatment is followed. Treating schizophrenia with an antipsychotic like Cloazpine has shown to reduce the amount of suicide attempts in patients. It is also the only FDA approved drug for treatment of suicidal behavior (“Bradvik”1). Treating your substance abuse patient, and even the substance abuse patient who also suffers from a mood/ personality disorder can be treated in a multitude of ways. There are including inpatient programs, prevention programs, and self-help programs such as Alcoholics Anonymous which have a degree of effectiveness. You also have pharmacological approaches too. The drugs that can be used are quiet extensive and target different issues the patient may be suffering. Addressing and treating the most obvious underlying issues like the ones discussed above for a suicidal patient is the best strategy to drastically cutting down on the amount of deaths each year.

                Albert Camus appeared to have strong feelings about suicide. It seems as though he could not quiet grasp what is was that would make someone decide that death by their own hands was an answer to the problems in their lives. In “The Myth of Sisyphus”, Camas said, “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy. All the rest — whether or not the world has three dimensions, whether the mind has nine or twelve categories — comes afterwards”.  I believe Camus would continue to ponder whether the absurd events in people’s lives really dictated a need to end their lives. I feel like he would think the number of deaths every year related to suicides itself would be absurd.

            It’s eleven o’clock in the evening and you see the screen on your phone light up, you see your sisters picture illuminate the face of the phone, your heart sinks immediately because you know she never calls this late on a week night unless it is important. You answer it and without ever exchanging a word you hear the devastating sobs and screams, in that instance you know your mother is gone. Suicide is a horrific epidemic that sadly every year continues to grow. The worst part about this issue is there is not just one cause for it, there is a multitude of issues that lead to a person choosing to end their life. How do you stop such an epidemic when there are so many causes? You start with addressing the main issues that seem to lead to suicide. When studies show that a majority of suicide victims suffered from a mental disorder, you address those mental health and substance abuse issues. You focus on what you can fix in the here and now. We still do not know whether this is truly a genetics issue, a misfire in the brain, a fault in your genetic strand somewhere but what we do know is mental health comes up repeatedly. The sad thing about this epidemic unlike so many others, is it leaves your loved ones behind struggling to figure out why and how. Why did you do this? How could they have stopped this? When you have experienced a loss like this not once, or even twice but three times by someone you have loved you continually wonder what if. There will always be what ifs, but there will always be indicators to a person’s condition as well. You can never stop fighting for those who have had suicidal tendencies that screamed “look at me” or “I need help” the minute you stop fighting and you think they are ok is the moment you lose them. I know there are hundreds of epidemics but when you have experienced the same one three times you realize there isn’t another one that compares. So many epidemics of our past have been irradiated simply by vaccines, and issue like suicide unfortunately does not have a cure as simple as that. I thoroughly believe even with mental health care and substance abuse treatment that we will ever be able to eradicate the problem but we can definitely put a drastic drop in the numbers.

  

Works Cited

"Adolf Hitler Commits Suicide in His Underground Bunker." HISTORY, 24 Nov. 2009, www.history.com/this-day-in-history/adolf-hitler-commits-suicide. Accessed 11 Oct. 2019.

Brådvik, Louise. "Suicide Risk and Mental Disorders." PubMed Central (PMC), 15 Sept. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6165520/. Accessed 14 Oct. 2019.

Camus, Albert. The Myth of Sisyphus And Other Essays. Wordpress, 2012, postarchive.files.wordpress.com/2015/03/myth-of-sisyphus-and-other-essays-the-albert-camus.pdf. Accessed 1 Nov. 2019.

"Cleopatra Dies by Suicide." HISTORY, 9 Feb. 2010, www.history.com/this-day-in-history/cleopatra-commits-suicide. Accessed 11 Oct. 2019.

"Definition of SUICIDE." Dictionary by Merriam-Webster, www.merriam-webster.com/dictionary/suicide. Accessed 27 Sept. 2019

Hedegaard, Holly, et al. "Suicide Mortality in the United States 1999-2017." Centers for Disease Control and Prevention, NCHS, Nov. 2018, www.cdc.gov/nchs/data/databriefs/db330-h.pdf. Accessed 18 Oct. 2019.

"National Institute of Mental Health - Suicide." NIMH, Apr. 2019, www.nimh.nih.gov/health/statistics/suicide.shtml. Accessed 26 Sept. 2019.

Nagel, Thomas. "A BRIEF HISTORY OF SUICIDE." Soars, www.soars.org.uk/index.php/about/2014-06-06-18-57-53. Accessed 8 Oct. 2019.

"Risk of Suicide." NAMI: National Alliance on Mental Illness, www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Suicide. Accessed 9 Oct. 2019.

Winerman, Lea. "By the Numbers: An Alarming Rise in Suicide." Https://www.apa.org, www.apa.org/monitor/2019/01/numbers. Accessed 9 Oct. 2019.